Supervisor, Claims- Subrogation/Workers Compensation

Claims Supervisor

The Claims Supervisor is responsible for supervising the staff of Claim Examiners and Claim Team Leads. The expectations include providing coaching, mentoring, and training while promoting quality and superior customer service. The Claims Supervisor is accountable for identifying opportunities for enhancements and changes to workflows to increase effectiveness and productivity of the team. Provides on-going feedback to the team and identifies areas for improvement and growth. Must be able to make independent decisions, prioritize workload effectively and collaborate with other internal departments to assist in meeting our corporate goals.

Primary Responsibilities

• Effectively supervise 7-12 direct reports—consisting of claim examiners and claim team leaders.
• Provide full-time technical support to team, internal departments, vendors, and customers.
• Distribute daily work to the team and monitor aging inventory resolution.
• Train new hires, vendors, and existing staff as needed.
• Research and respond to escalated issues and pertinent information on claims requiring adjudication.
• Review and process High Dollar claims and conduct quality reviews of claims and logic changes/updates.
• Assist Customer Service in resolving customer questions and concerns.
• Researching and resolving client inquiries and performing client-requested claim adjustments.
• Coach, counsel, and mentor employees to meet quality, claims accuracy, and productivity standards, and address performance and disciplinary issues.
• Manage payroll, time sheets, employee schedules, and time off requests.
• Support internal audits and request recoupments, as necessary.

Essential Qualifications

• 3+ years of experience in supervisory or leadership role.
• Advanced knowledge of Excel.
• Strong knowledge of contracts, medical terminology, and claims processing and procedures and subrogation/workers compensation.
• 5+ years of advanced claims adjudication experience, including facility, professional, and ancillary claims.
• Excellent written and oral communication, interpersonal, and negotiation skills with the ability to prioritize tasks.
• Problem-solving and organizational skills, ability to prioritize and multitask effectively.
• Ability to establish and maintain positive work relationships with clients, coworkers, members, providers, and customers.
• Enthusiastic attitude, cooperative team player, adaptable to new or changing circumstances.
• Bachelor's Degree or comparable experience in the healthcare field preferred.